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Frequency of Multidrug-Resistant Organisms Cultured From Urine of Children Undergoing Clean Intermittent
Catherine S Forster1, Joshua Courter2, Elizabeth C Jackson1,3
1Department of Pediatrics.
Insights
Antimicrobial resistance is increasing in children undergoing clean intermittent catheterization (CIC). Rates of third-generation cephalosporin resistance significantly rose between 2008 and 2014, necessitating vigilant monitoring in this vulnerable population.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Clinical microbiology
Background:
- Children undergoing clean intermittent catheterization (CIC) are at high risk for infections due to antimicrobial-resistant bacteria.
- Specific concerns include resistance to vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and extended-spectrum β-lactamase (ESBL) producing organisms (3GCR).
Purpose of the Study:
- To analyze trends in antimicrobial resistance, specifically VRE, CRE, and 3GCR, in pediatric patients undergoing CIC between 2008 and 2014.
- To determine the association between year and resistance rates in this population.
Main Methods:
- Retrospective study of urine culture and antimicrobial susceptibility data from 14,832 children (≤18 years) undergoing CIC from 2008-2014.
- Isolates identified as VRE, CRE, or 3GCR.
- Simple linear regression used to assess the relationship between year and resistance rates.
Main Results:
- 3997 positive urine cultures analyzed.
- Prevalence: 4.6% VRE, 11.1% 3GCR, 0.4% CRE.
- Significant increase in third-generation cephalosporin resistance and CRE from 2008 to 2014 (P < .01).
- Resistance to third-generation cephalosporins increased significantly over time, unlike CRE or VRE.
- Higher rate of third-generation cephalosporin resistance increase in CIC patients compared to non-CIC patients.
Conclusions:
- A significant increase in third-generation cephalosporin resistance was observed in children undergoing CIC over a 7-year period.
- This trend highlights the need for careful monitoring of antimicrobial-resistant organisms in this specific pediatric group.
- Continued surveillance is warranted to address rising antimicrobial resistance in CIC patients.
Background:
Children undergoing CIC frequently have positive urine culture results and receive many antimicrobial agents. Subsequently, this population is at high risk for infections caused by antimicrobial-resistant bacteria. Resistant pathogens, such as vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and organisms that produce extended-spectrum β-lactamases (ESBLs), which are third-generation cephalosporin resistant (3GCR), are of particular concern.
Methods:
In this retrospective study, all urine culture results and antimicrobial-susceptibility testing results were obtained between January 2008 and December 2014 from the electronic health record of children ≤18 years of age who were undergoing CIC (n = 14 832). Isolates were identified as VRE, CRE, or 3GCR. Organisms of the same type that were obtained in the same year and with identical antibiotic susceptibilities from the same patient were excluded. Simple linear regression was used to determine the association between year and rates of resistance.
Results:
A total of 3997 positive culture results were included in this analysis. Of all Enterococcus isolates for which susceptibility results were available, 4.6% were VRE, 11.1% of all isolates that belonged to the Enterobacteriaceae family were 3GCR, and 0.4% of eligible isolates were CRE. There were significantly higher rates of resistance to third-generation cephalosporins and CRE in 2014 than in 2008 (P < .01). Simple linear regression revealed a significant association between year and rate for resistance to third-generation cephalosporins but not for CRE or VRE. The rate of increase in resistance to third-generation cephalosporins in patients who required CIC was higher than that in patients who did not need CIC.
Conclusions:
The rate of resistance to third-generation cephalosporins has increased significantly in the past 7 years in children undergoing CIC, which indicates that careful monitoring is warranted for continued increases in antimicrobial-resistant organisms in this unique patient population.
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